Sanitization and disinfection of high-risk areas in hospitals

For these reasons, it is the responsibility of the infection control team to develop guidelines and procedure manuals for asepsis, quarantine, and disinfection techniques in high-risk areas of the hospital. Specifically, hospitals are required to:

• Analyze which areas are high-risk.
• Perform targeted monitoring of nosocomial infections by conducting data analysis and implementing corrective actions.
• Provide staff recommendations regarding infection control and the maintenance of a safe environment for everyone.
• Monitor and control cleaning and hygiene practices.
• Oversee cleanliness, sterility, disinfection, the use of disinfectants, and quality control.
• Advise on the supervision of high-risk patient management and isolation procedures.
• Investigate infection outbreaks and take corrective measures to control and prevent them from occurring.
• Operate comprehensive waste management.
• Organize regular training programs for staff to ensure that infection control practices are in place.
• Review infection control procedures and antibiotic usage.
• Use exclusively professional products approved by the Ministry of Health via the National Commission for Biocidal Products

Active monitoring of infectious diseases

Active monitoring should be carried out at least in high-risk areas. High-risk areas in various settings include:

• Intensive care units (neonatal intensive care unit, pediatric intensive care unit, cardiovascular surgery intensive care unit, respiratory infection unit).
• Operating rooms.
• Dialysis unit.
• Burn unit.
• Transfusion service.
• Food processing areas.
• Central sterilization service.

Other high-risk areas that require cleaning and disinfection include:

• Customer care area.
• General waiting area.
• Other areas where staff or objects that patients and hospital staff frequently touch are located (door handles, sinks, toilets, various surfaces and objects near the client).
• Household surfaces, such as floors and walls, do not need to be disinfected unless they are visibly contaminated with blood or body fluids. Usually, they can be cleaned only with detergents or cleaner/disinfectants. KLINTENSIV® – Concentrated disinfectant detergent

Types of disinfectants that can be used for infection prevention

Most disinfectants are ineffective in the presence of dirt and organic matter. Therefore, surfaces must first be cleaned before being disinfected.

Some pathogens, such as norovirus and Clostridium difficile, are not inactivated by commercial disinfectants commonly used in the public health sector.

If contamination with these pathogens is suspected, it is recommended to use professional disinfectant solutions for decontaminating surfaces and objects.

Monitoring is one of the essential stages of an effective infection control program. It is defined as the systematic collection, analysis, interpretation, and dissemination of data on the development of infections in a patient population.

The infection control process in hospitals

Hospitals must follow the recommendations and requirements for high-risk areas, and the following standard precautions must be taken.

Hand hygiene

Hand hygiene through washing and disinfection must be performed regularly. If hands are visibly soiled, if there is evidence or an urgent suspicion of exposure to spore-forming organisms, or after using the toilet, hygiene must always be performed with soap and water. Only afterwards should a disinfectant solution be applied. Hand hygiene not only protects medical staff but also helps prevent indirect transmission from patient to patient. ALCHOSEPT® – Disinfectant for hands and skin

Personal protective equipment

Before carrying out medical activities, it is necessary to assess the risk of exposure to contaminated body substances or surfaces. Protective equipment shall be chosen based on the risk assessment:

• Clean, non-sterile gloves
• Clean, non-sterile, fluid-resistant gown
• Mask and eye protection or face shield

Disinfection and handling of patient care equipment

The goal is to prevent the transmission of microorganisms to medical staff and other patients. Contaminated or improperly cleaned patient care equipment can transfer organisms to the patient through direct or indirect contact during treatment.

Medical staff must always handle contaminated patient care equipment in a way that avoids contaminating themselves, the environment, or other people. Performing hand hygiene procedures immediately after removing gloves or disposing of the device is mandatory.

Cleaning, disinfection, and sterilization

Disinfection is required when most microorganisms, with the exception of spores, are removed from a defined object or surface. Disinfectants can be classified according to their ability to destroy different categories of microorganisms.

• High-level disinfectant: 2% glutaraldehyde, ethylene oxide
• Intermediate-level disinfectant: Alcohol, chlorine compound, hydrogen peroxide, chlorhexidine
• Low-level disinfectant: benzalkonium chloride, some soaps

Professional disinfectants for hospitals

General guidelines for the disinfection of surfaces and instruments in hospitals

Critical instruments/devices (i.e., those that penetrate the skin and mucous membranes) must be sterilized before and after use.

Semi-critical instruments/devices (e.g., those that do not penetrate and do not encounter intact mucous membranes) must be high-level disinfected before and intermediate-level disinfected after use. Example: endotracheal tube.

Non-critical instruments/devices (e.g., those that encounter intact skin and not mucous membranes) require only intermediate or low-level disinfection before and after use. Example: EKG electrode.

Sanitization and disinfection of high-risk areas

The sanitization process involves the mechanical cleaning of interior and exterior surfaces. In the case of medical equipment, this step includes brushing internal channels and rinsing each internal channel with water and a cleaning agent or an enzymatic cleaning agent.

For the disinfection stage, solutions effective against pathogens will be used. These will be applied to all accessible channels, such as suction/biopsy channels and air/water channels, respecting the time recommended by the manufacturer.

It is also required to disinfect high-touch surfaces (bedside tables, bed rails, laboratory surfaces, etc.) regularly and if they are visibly dirty. If these surfaces are visibly contaminated or dirty, the walls, blinds, and window curtains in the patient care area will also be cleaned and disinfected.

The use of very strong disinfectant solutions or chemical sterilizers to disinfect non-critical surfaces is not recommended.

Monitoring of biomedical waste disposal practices

The disinfection protocol will clearly mention the staff responsible for the collection, handling, pre-disposal, and disposal of medical waste.

Spill handling – Liquid spill management: immediate cleaning of blood and other potentially infectious substances and removal of contaminated objects is required.

Broken glass and sharp objects will be removed with tweezers and gloves, and a large amount of folded paper towels will be used to trap small pieces of glass.

The floor will be covered with paper towels/absorbent paper/newspaper on which potentially infectious substances are spilled. Then, the contaminated area will be cleaned and disinfected. DESOGEN® – High-level concentrated disinfectant

Conclusion

The above recommendations are the basic infection control precautions for all high-risk areas in the hospital. In addition to the practices followed by healthcare professionals, all individuals (including patients and visitors) must comply with infection control practices in healthcare facilities. Controlling the spread of pathogens from sources of infection is the key to avoiding illness.